Obesity is the accumulation of excess body fat on a person to the extent it may have an adverse effect on health and is a leading, preventable cause of death worldwide. Adverse health effects due to obesity, which are a consequence of the mechanical or metabolic effects of obesity, range from mild to acute and often include development of comorbidities. These comorbidities include cardiovascular disease, diabetes and degenerative diseases of the cartilaginous tissue between the vertebral bones of the spine and other weight bearing joints. Treatment for mild cases includes dietary and physical exercise and severe cases require surgery. Bariatric surgery is a term encompassing all of the surgical treatments for morbid obesity. Every year there are more morbid obese and those who do seek bariatric surgery are heavier.
Meal digestion and absorption are time-intensive processes and bariatric procedures effectively reduce stomach volume and or bowel length and operate to promote earlier satiation, a perception colloquially referred to as ‘feeling full’. Inducing this feeling results in loss of desire to continue eating and a resulting reduction in caloric intake. Chyme is a semi-fluid mass of mechanically and chemically digested food which is produced by the stomach and expelled into the duodenum where it begins the journey through the gastrointestinal (GI) tract. To optimize digestion and absorption, transit of the meal through the GI tract is regulated by a complex integration of signals from the small intestine in response to nutrient sensing in the bowel or gut. Satiation results from signals originating in the stomach caused by distension and signals generated by the jejunal brake and ileal brake. Activation of the distal part of the gut, the so called ileal brake, leads to reduction in hunger and food intake. Collectively, the jejunal brake response and ileal brake response are referred to as intestinal brake.
Intestinal brake has been shown to initiate satiation more quickly and is theorized to play an important role in the effectiveness of bariatric surgical procedures such as Roux-en-Y gastric bypass (RYGB) and has shown both excess weight loss (EWL) and comorbidity resolution. Bariatric procedures such as Ileal Transposition have been developed based on the concept of delivery of substances with rich nutrient/caloric content to the ileum in order to trigger the intestinal brake response and have been shown to be effective in numerous animal models. Food reaching the ileum contributes to L-cell stimulation and production of glucagon-like peptide-1 (GLP-1) hormones that signal satiety leading to the cessation of hunger and a corresponding loss of desire to eat. Transposition of the terminal ileum to the duodenum provides GLP-1 whenever glucose is ingested. The presence of fat or glucose in the duodenum or the ileum has shown to increase GLP-1. Also known as the “ileal-brake” hormone, GLP-1 slows down or stops emptying of the stomach and slows motility of the small bowel thus promoting earlier satiation and increasing the effectiveness of bariatric procedures.
Accordingly, there remains a need for methods and devices of rerouting chyme to induce intestinal brake in order to improve the effectiveness of bariatric surgical procedures and to improve comorbidity resolution.